Monday, 14 May 2012

The NHS: Oh, the joys!

Picture yourself being a nurse – you are kind, you are caring, you are administering your care onto grateful patients who feed you lots of chocolate, fluffing their pillows along the way as your colleagues appreciate your humour and your delightful ways and you go home after every 12.5 hour shift knowing you’ve made a difference in someone’s life.

I’m not sure if I had quite that picture in my head BEFORE I started nursing but it wasn’t that different. The reality of nursing is quite different – hospital trusts are under extreme pressure to cut their budgets, getting less funding and having to admit more patients (in order to generate income) with less staff. In my last shift we were so short staffed that I was still trying to get people out of bed and washed well into the afternoon – in fact, I had to interrupt my washes and bed making to serve them lunch. Patients were getting grumpier by the hour and the nursing staff more and more stressed. And there you are as a sweet, innocent student nurse – smack in the middle of an explosion waiting to happen.

Why am I mentioning this? Well, because on top of solid interpersonal skills and having a caring nature, a potential student nurse really needs to be resilient (by resilience I mean being able to recover quickly from difficult situations). I can guarantee you that in your entry interview you will be asked some sort of questions regarding how you deal with stress, difficult situations or how you’ve dealt with past difficulties. The reason that is asked is that you are going to have more soul-destroying days than you care to think about at the moment. And how would you deal with that? You’re exhausted, you’re on your third shift in a row, you’ve barely slept or eaten well, you vaguely remember what your boyfriend/girlfriend/partner or friends look like, you’ve killed your goldfish, you’ve misplaced your children somewhere and there you have a patient’s relatives yelling at you because their mother hasn’t gone down for the scan yet and they’ve been waiting since the morning (it is 11:25am). You try and explain that the Imaging department doesn’t fall under nursing management and that they NEVER tell you when inpatients are going to be coming down because they have a long list of outpatients and have to deal with emergency imaging from A&E and ITU. It all falls on deaf ears – they are convinced you are personally keeping their poor Mama in the hospital for longer than is necessary. You try the old trick of saying you’re a student nurse and why don’t you just pop out of the bay (i.e. escape) and get the nurse who is in charge of the bay but this only makes them angrier. What do you do? How would you react?

a) You don’t take it personally, you promise them it will be done today and why don’t you just go give those nice, accommodating Imaging people a call to confirm it/hurry it along?

b) You listen empathetically but wonder what kind of day it’s going to be if this is happening already at 11:25am. When they’ve finished you patiently explain the same thing again which unfortunately comes down to there are no fixed appointments for inpatients and it gets done by prioritising cases. Which is the equivalent of saying: it’s out of my hands, it gets done when it gets done.

c) You look out the window as if there’s something really interesting and when they turn to look, you vanish into thin air (this doesn’t work if the relatives are in pairs – one never looks away).

d) This is a trick scenario. No way would this happen!!!!

If you’ve picked D, you’re probably right. On top of the screaming relatives, you’re going to have at least one patient per bay (1 in 6 at the very least) who no matter how busy you are, no matter what you are doing (even if you are giving someone CPR), is going to turn around to you, in the most inconvenient time, and say, “Love, when you have a minute, can you just go get me some ice? I must have ice for my water” (actually this did happen to me – someone had a cardiac arrest and we all rushed into the bay and an old dear did ask me to go get her some ice, just before I was to start doing CPR compressions). If you’ve picked A, I’m going to guess that you haven’t done a lot of work in hospital. My top tip: don’t promise irate people things you don’t know you can keep. If it’s another department, you don’t know what’s going on with them and what kind of day they’re having. And no one likes to be bugged about what they have to do in a hospital so unless you know the hospital, the staff and their ways of doing things, I’d steer clear of chasing things, especially as a scan can happen at 8am or 20:00. It’s not that you can’t, it’s that you should know how things are done before chasing things up.

But it is a trick scenario because you cannot know how you would react until you are confronted with this. And some days are going to be better than others. And you will learn how to diffuse situations. It’s not the situations themselves that are important but how you feel inside yourself when they are done. Do you share your frustration with a colleague and it’s done and you go back to work or are you still fuming over it when you are handing over your patients at 19:30? And though you may weather one day like this, what happens to your wellbeing when you have more demoralising days than you care to count? One word: resilience. Learn how to bounce like a tennis ball in Wimbledon and you’ll be fine.

Why do I come back? Well, just when I’m having the worst day possible, when I think I cannot possibly cope anymore, a patient comes up, squeezes my hand and thanks me for all I’ve done for them today. Or a relative will come and say how their father has really praised my work and how kind I’ve been. And then I think, “Well, maybe I’ll come back after all”. And maybe Scarlet O’Hara was right – after all, tomorrow is another day.

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